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Move from Traditional Change Management
to Agile Methodology
Session #139, February 13, 2019
Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS Chief Nursing Informatics Officer,
Banner Health
Jean Palazzetti, MSN, MBA, RN, Sr Dir Nursing Informatics, Banner Health
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Sherri Hess, MS-IS, BSN, RN-BC, FHIMSS
Jean Palazzetti, MSN, MBA, RN, HCM
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Pre-Agile Landscape at Banner Health
• Why agile
• Agile principles
• How to implement agile
• Benefits of agile
• Data to support
• Retrospective
Agenda
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• Explain the importance of moving from traditional
change management to Agile methodology
• Explain how to implement a governance model to
support an agile, rapid methodology
• Describe the importance of a data driven
approach, using analytics to lead design
• Identify three principles in Agile methodology
• Describe three benefits of Agile methodology
Learning Objectives
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Banner Health System
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Dare To Dream
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Polling Question
How long from request for an enhancement to implementation?
1. 0-3 months 3. 6-9 months
2. 3-6 months 4. 9-12 months
How many requests are in your backlog?
1. Under 100 3. 300-600
2. 100-300 4. Way too many to count
Are your end users satisfied with your enhancement process?
1. Delighted by the process
2. Saddened, needs improvement
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• Significant growth
• New venues of care delivery
• Essential Clinical Data Set
• Clinician satisfaction
• Patient Obsessed culture - Sofia
• Minimal data used to drive
changes/enhancements
Landscape For Change
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• Enhancement process long
• Unclear on decision making process
• Metrics unclear
• Large meetings – poor decision making
• Education was “one size fits all”
Why Agile?
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Waterfall Change Management
– Converted large academic
system
– Enhancement request was
complex
– Large backlog of requests
– Adoption low
– Communication was
challenging
– Rarely went back to
measure success
Pre Agile
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Which Landed Us Here
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18,000 Nurses
Done
Done
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Agile Principles
• Satisfy customer-early and continuous delivery
• Welcome change
• Individuals and interactions over processes and
tools
• Working software over comprehensive
documentation
• Customer collaboration over contract negotiation
• Respond to change over following plan
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• Training
• Assemble the teams
• Start-DO SOMETHING
• Scrum meetings
• Grooming sessions
• Retrospectives
How To Implement
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Benefits Of Agile
• Whole team & stakeholders (SMEs) at the
table real time
• Simplicity
• Reflection & Fine Tuning
• Team size
• Work broken down into manageable units
• Focus on quality
• Frequent delivery
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Capabilities Completed
Average:
• 23 Capabilities
per Iteration
Total Counts:
• 362 Complete
• 17 Ready
• 86 In Progress
• 299 Backlog
1
2 2 2
3
2
3
2
7
9
5
4
8
1
2
1
1 1
1
2
2
1
6
1
2
11 5
10
8
5 5
12
6
8
9
10
15
24
1
1
4
3
2 2
2
3
3
3
1 1
2
6
1
2
6
1
6
5
1
6
6
3
1
1
2
3
1
4
3
2
5
8
4
10
9
7
7
7
8
7
3
0
5
10
15
20
25
30
35
40
45
Iteration
01
Iteration
02
Iteration
03
Iteration
04
Iteration
05
Iteration
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Iteration
07
Iteration
08
Iteration
09
Iteration
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Iteration
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Iteration
12
Iteration
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Iteration
14
Iteration
15
Iteration
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Ambulatory Consumer/Portal Cross Venue Operations
Hospital Based Medicine Lab Meds Process
Procedural Specialty Medicine
Break/Fix
Only
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Orders to Scheduling
Decreased the
turn around time
from procedure
order to actual
scheduling time
by 36.4%
Equated to 2
days and 4 hour
reduction
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• Baseline
– 25.40% of the orders were scheduled within
the first 24 hour of the order being placed
– 10.31% of orders were scheduled between
24-48 hours
– 35.71% of orders were scheduled within the
first 48 hours
• Comparison
– 43.12% of the orders were scheduled within
the first 24 hours of the order being placed
– 11.22% of orders were scheduled between
24-48 hours
– 54.34% of orders were scheduled within the
first 48 hours
Increased the amount of orders
scheduled within 48 hours by 52.2%
52.2%
Baseline: February 2018
Go Live: September 5, 2018
Comparison: October 2018
Excludes: Orders with a turn around time greater than 28 days
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Prevented 534,532 mCDS alerts for all users
6.4+ million projected prevented mCDS alerts over 12
months for all users
Data Source: Millennium
Baseline: 3/1/18 – 3/31/18
Comparison: 8/8/18 – 9/8/18
534,532
prevented mCDS
alerts over 1
month for all users
6.4+ million
projected prevented
mCDS alerts over 12
months for all users
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ED Physician Efficiency Metrics
Adjusted Time in EMR per patient reduced from 19 min 42 seconds to
11 min 59 secs. Total of nearly 8 minutes!
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• Interdisciplinary team
• Triad approach
• Feedback Loop
• Dedicate resources
– Support
– Education
– IT
– Informatics
Aligning Support To The Work
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Banner Comprehensive Approach
Agile
Governance
ECD
Clinically
Driven
Data
Utilization
Efficiency
Analysis
ECD/Model
Subjective
Survey
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• What went well
– Hit the ground running
– Teams engaged and Leaders
supportive
– Stakeholders on board
– Large amount of work done in a short
amount of time
– Clinicians eager for optimization
Post Agile Retrospective
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• Lessons Learned
– Not all pieces have to be done in one
iteration
– Review usage and efficiency analytics
before and after
– Take time to address poor adoption
– Put all projects in one place
– Don’t bombard one group with too many
changes
– May be too agile
Retrospective, cont’d
